THE WAIT – Healthcare in Vanuatu

A young woman shows off her chest X ray after a visit to the Peace Ark, a Chinese PLA Navy hospital ship. photo: Graham Crumb – imagicity.com

The failures of Vanuatu’s health services are felt by everyone. But these shortcomings are particularly vivid to me today. As I was working on PiPP’s latest multimedia story on the state of health care in Vanuatu, I buried two friends on consecutive days. I have not the slightest doubt that they would both be alive today if they lived in Auckland or Sydney.

Danny Tetiano and Dr John Otto Ondawame were both influential, important people. One was a gifted musician, mentor to a generation of aspiring artists in Vanuatu. The other, of course, was one of the leaders of the West Papuan independence movement. In addition to the loss to society and to the world, both left grieving widows and young children behind.

To put it plainly, Danny and John died of poverty, not disease.

The cost to society is immense. One of the very reasons West Papuans have struggled to organise themselves and become a well-defined locus of international attention is the lack of well-educated, dynamic people, skilled in persuasion and diplomacy. They lack entrepreneurs to improve prosperity, education to create the entrepreneurs, and health services to preserve and protect them.

The lack of basic services is characterised as systemic abuse when Indonesian government policy is concerned. But how should we characterise such neglect in Vanuatu?

Health services in Vanuatu – there is no health system, per se – are rudimentary at best. Post-operative infection rates make even the most run-of-the-mill surgery a cause for concern. One long-time acquaintance died following the amputation of his big toe. A well-intentioned (but unforgivably vague) blog post by the UNDP raises the point that life expectancy in Vanuatu and other Pacific island countries is ten years less than in Australia and New Zealand.

Ten years, and three hours flight away.

The difference is quantum. It’s at once tantalisingly close and achingly distant. But the bitter lesson that I’ve learned this week, and repeatedly in the past, is that the cost of inactivity is not an abstract one. Death impacts directly on a nation’s ability to grow, to gain experience, and ultimately to survive.

Web tricks are not for kids any more

I started writing web apps in 1994. Using CGI.pm in Perl was pretty much state of the art – and the art wasn’t very pretty. ColdFusion appeared shortly thereafter, but only supported basic control structures – no functions or even subroutines at the start. Then came ASP and a disastrous mishmash of security holes, ActiveX objects being called from the only thing worse than PHP for tag soup with spaghetti code for filler. PHP, for our sins, went from being a ‘hey, kids, look – I made a web page!’ app to an actual application platform.

.. and the list goes on.

I’ve lived through the browser standards wars, I’ve seen such sins committed in the name of the Web that I would wake up screaming, ‘Why, Tim Berners Lee?!? WHY???!!’ I’ve lived through <BLINK>, Flash, animated GIFs, <MARQUEE>… and other monstrosities whose names Shall Not Be Spoken.

I’ve used JavaScript since it was a toy.

But this, my child, is the key: It’s not a toy any more. Finally, after two decades of stumbling around blindly, wreaking more chaos and mayhem than a shirtless, drunken Australian on a JetStar weekend in Bali, web development has finally matured. A bit. It’s learned that being cool doesn’t earn you nearly as many friends as being useful. It’s learned that a guy’s gotta eat, fer Chrissakes, and sleep from time to time. It’s learned that popsicle-stick bridges may be neat, but won’t carry the load that a boring old concrete one will.

But, as the scripture says, ‘then I put away my childish things.’ Oh, it’s true that just because we’ve grown up doesn’t mean we’ve learned every lesson ever. It’s true that we Web Developers still get seduced by Teh Shiney. But all in all, we’ve grown; we’ve lost our innocence and our hair. But we sleep at night. And we parallelise. And we scale. We’re grown-ups now. With grown-up tools.

So put down your PHP child. Accept that JavaScript is a language. REST in your Bower and accept that some change is for the better.

Only my first robin

but it was only my first robin

Every day I face the suspicion
that you have had secret springtimes

sunlights that you hid from me
clandestine pussy willows camouflaged
whole choirs of spring peepers
cued by no baton but yours

hidden nations of tulips
daffodils and crocuses
held in boxcars
and run through town at night

without stopping no lights
no whistles

I don’t know which of us to worry for

Song

I’m waiting for the song that writes itself,
A choir of one with hymn sheet white and clear,
Whose even blankness is a kind of wealth.

A coruscating symphony of stealth,
At once a glance to Heaven and a leer—
I’m waiting for the song that writes itself.

A city full of strangers, smug in health,
Devoid of life and liberty and fear,
Whose even blankness is a kind of wealth,

Averse to dying as to life itself:
They will persist, though cities disappear.
I’m waiting for the song that writes itself.

The teacup cracking on the kitchen shelf,
Discarded with a backward-looking tear
(Whose even blankness is a kind of wealth),

The brahmin contemplating loss of self…
Both gravitate toward something too austere.
I’m waiting for the song that writes itself.

I cannot hum it, even to myself,
Nor puzzle out its immanence, this fear
Whose even blankness is a kind of wealth.

Existence has a price that’s far too dear,
But nothingness? A trifle too severe.
I’m waiting for the song that writes itself,
Whose even blankness is a kind of wealth.

Sisters

And Love says
to Death, “That’s the last time
I let you borrow my clothes.
Just look at these wrinkles–
and that stain! My God.
What did you DO?”

(Whacks her over the head
with a hairbrush, and they’re
scrapping all over the room.
Love comes up short one
tooth.)

She screams, but Death,
her eyes are burning like dull coals:
“You just don’t know, do you?
You never never try to understand.
Well it was an accident
but right now I’ve a mind
to accident you.”

(Love is hysterical.)
“You wouldn’t,” she screams.
“You never could!”
(Runs out in tears. Never comes back.)

My heart announced

My heart announced today that it will leave.
It kicks in expectation like a child
in the womb, a trapped miner at piled
timbers: long past the urge to grieve,
he gathers up the threads of air that weave
life in darkness, then is reconciled
and only waits. I am no more beguiled
by death than he. Still, my heart will leave.

The unborn child cannot begin to fear
the pain his mother feels, the open wound
that he creates, and when she draws him near
no memory will scar him. All too soon,
I will live this parturition. Pleasure
has no gift to match this last long measure.

The potholed road to prosperity

Originally published on Pacific Politics

Vanuatu’s budget books, released earlier this month, reveal a fairly healthy economy. When you look at the broad strokes, that is. But they are far less revealing than they should be about the road ahead for the tiny island nation.

Overall, the economic news is okay. Revenues have improved significantly, largely because customs and inland revenue has tightened up its processes. Businesses are now closer to paying what they actually owe. The world economy is improving, and so is Vanuatu’s. Growth is expected to increase, from 3.3% in 2013 to 5.1% in 2014, and even higher in 2015. Inflation will remain low, likely less than 3% in the coming year. The government is taking on USD 5 million in new debt in order to contribute to a number of largely donor-funded infrastructure projects.

But dig a little deeper, and things appear less rosy. The budget does little to reflect the government’s goal of ‘a Just, an Educated, Healthy and Wealthy Vanuatu’. Overspending on scholarships in 2013 has not only left the department of education constrained at the very moment when it should be investing heavily in teachers, schools and educational resources, it’s diverted money from other areas as well.

In health, things don’t look so good either. Whatever we may think about the department’s recent decision to focus on medicine to the exclusion of other activities, it’s clear that much could be done to improve the ministry’s policy-making and implementation processes. A recent outbreak of dengue in Port Vila has caught it flat-footed. The cost in terms of medical care and, potentially, in lives, will only add to the nation’s burden.

Vanuatu managed to get through the recent global economic downturn with less damage than some of its neighbours. Some part of this is due to the government’s efforts in recent years to liberalise certain sectors, to improve conditions for businesses large and small, and to improve its own administrative processes as well. The result is that the country is a better place to do business than it was.

But we’re facing a welter of challenges still. The 2010 census contains stark evidence that the country is becoming increasingly urbanised. When peri-urban neighbourhoods like those surrounding the Port Vila and Luganville municipalities are factored in, we see that the old 80/20% rural/urban split no longer holds. Over the last few years, falling commodity prices and lack of opportunity have drawn more and more young adults into our towns. Back in 2010, the division was closer to 70/30, and based on observation alone, it’s clear that this trend is continuing at a rapid pace. Continue reading →

End of an age….

In an online discussion concerning an ‘old-school’ geek’s fear of change, there was a lot of back and forth concerning luddism on the one hand and change for change’s sake on the other. At one point, someone chastised the poster for his trepidation.

“I’m going to guess he’s going to look back on his life and realize that he was dumb to think he’d seen it all at age 24. He talks as though the Third Age of Middle Earth is ending…”

In some important ways, it is. The process isn’t complete, but there is a fundamental change happening, and it will discomfit some of us.

The days of ‘Homesteading the Noosphere‘ (as ESR put it), are coming to a close. Scale, network topologies, business models and legal encroachment on the principles of individual online freedom are all conspiring to make the technological world we live in substantially more constrained than it’s been since the internet became part of our lives.

The land rush is over, the cowboys are gone (either buried or rich) and the homesteaders are being bought out by the speculators and tycoons. Community-based governance is under siege by national and international interests.

And this is being reflected in the tech world. The craftsman’s approach to software (always greater in repute than in reality) is decidedly more difficult to practice as a trade than it was. Toolkits are giving way to frameworks and apps replace applications. Backyard-mechanic roadsters and dirt-track races are swallowed up by Nascar – VCs get us excited by the prospect of building only big enough to sell out to someone bigger.

The physical networks themselves are being taken back by the telcos and proffered to governments for surveillance in exchange for ever more egregious rent-seeking behaviour. What we used to call sharing is now piracy. The word ‘copyright’ now means ‘don’t copy at all, ever.’

And in the midst of it all, we’re grateful to lockin-vendors who make Free software difficult, if not impossible, to use. We rent what we used to own. Even our identities are no longer our own.

I grieve to say it, but unless there’s a sudden and immense resurgence of the DIY spirit, especially in peer networking and distributed data, we’re going to fall back into the bad old days of the dumb terminal and the smart network. And that network’s smarts will not exist for our benefit.

I’m pushing 50 now, and do I fear change? Not really. I just regret the lost freedom, the creative anarchy of the ’90s, the ability to hack something cool and new, the chance to achieve things never before possible. It’s not gone yet. We could still turn things around. But every day we don’t brings us a day closer to the day when we can’t any longer.

THE SCRIPTORVM

Collected essays, columns, etc. by Dan McGarry

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